When asthma interrupts sleep in children - What is the best strategy?

Nocturnal symptoms of asthma such as coughing, wheezing, dyspnoea and dyspn oea on awakening are common in children with asthma. This is an important i ssue since nocturnal symptoms may have a negative influence on the child's life, affecting, for example, school performance or quality of life. Only a minority of the patients report their nocturnal symptoms spontaneously. Do ctors should therefore specifically ask if a child is experiencing such sym ptoms. Nocturnal airflow limitation, induced by an increase in inflammatory activity, is thought to be responsible for these symptoms. Several other f actors, both endogenous and exogenous, contribute to this fall in lung func tion. Therapeutic regimens aim to reduce inflammation and the subsequent co nstriction of the smooth muscle cell. Environmental measures, like smoke av oidance or house dust mite reduction, can reduce the exposure to exogenous triggers, while inhaled medication acts specifically on the inflammation or smooth muscle cell constriction. Treatment with inhaled corticosteroids; h as a positive influence on lung function and the degree of bronchial hyperr esponsiveness. Since short-acting bronchodilators provide dilation for only 4 to 6 hours, their role in the treatment of nocturnal symptoms is less im portant, especially in children. Long-acting bronchodilators, such as susta ined release theophylline, have been shown to improve nocturnal symptoms an d (nocturnal) lung function. However, the small therapeutic range of those agents with respect to plasma concentration is a complicating factor for tr eatment of children with asthma. Long-acting beta(2) agonists have a positi ve influence on nightly awakenings and lung function. Some studies indicate , however, that the combination of a long-acting beta(2) agonist with an in haled corticosteroid is superior to long-acting beta(2) agonists alone.